Pain at the back of the heel is termed "posterior heel pain". Most posterior heel pain happens due to overuse, poor fitting shoes or sandals or from overtraining. If you are experiencing pain at the bottom of the heel, the cause is most likely plantar fasciitis.
If you are experiencing pain at the back of your heel that is not due to a skin injury (such as a blister) or a bone injury (chipped bone or fracture) then it is almost certain that you are suffering from achilles tendinitis, bursitis or referred pain.
Tendinitis can be classified in two categories - acute tendinitis or chronic tendinitis. Acute tendinitis means you have experienced a recent injury in which your achilles tendon has become strained or partially torn. Chronic tendinitis means that you have had this condition for a lengthy period of time. A chronic case occurs when the Achilles tendon becomes inflamed over a period of time. This is often due to repetitive overuse, irritation or may be a result of acute tendinitis that has been left untreated or has not been allowed sufficient rest. It is common that the tendon becomes enlarged and inflexible due to the buildup of scar tissue.
Acute Achilles tendinitis is typically the result of an injury or specific event that caused a strain or tearing of the Achilles tendon. When the fibers of a tendon are torn, they become inflamed and swollen causing pain and tenderness in the area which can also result in difficulty flexing the foot during regular movements, such as walking and jumping.
Most commonly, this condition is seen in athletes who sit at a desk all week and then plays softball or tennis on the weekend. The aftereffect is tendon strain (mild tears) creates inflammation and pain and can lead to tendinitis. This condition could also be created if the tendon is strained from a sudden trauma such as a fall or misstep.
Achilles tendinitis can occur at the insertion point of the tendon (referred to as insertional tendinitis) at the calcaneus (heel bone) or mid way up the Achilles tendon (referred to as non-insertional tendinitis or "achilles tendinitis a the midpoint"). The most common area to be affected by acute tendinitis is approximately 1/3 of the way up the tendon, 2.5 inches from where it attaches to the heel bone. This part of the Achilles tendon is at most risk of tendinitis and other tendon injuries because it receives less blood flow than other parts of the tendon.
If you are suffering from Acute Achilles Tendinitis you will most likely be experiencing:
If you feel a sharp pain, as though you've been hit in the back of the ankle, and hear a "pop" sound, your Achilles tendon has likely ruptured. A ruptured (completely torn) Achilles tendon can occur when the Achilles tendon is overstressed to the point of tearing. It will be very difficult for you to walk or move your ankle if this is the case.
Acute Achilles tendonitis may be caused by:
Achilles tendinitis is one of those injuries that can really bring down the quality of your life. Anyone - young or old - can suffer from this injury, and if you're active this condition will keep you from doing the things you love to do. It will even start interrupting any of your normal daily tasks and make living life harder than it really needs to be.
Chronic Achilles tendinitis can be a difficult condition to treat due to the build up of scar tissue on the tendon. Scar tissue can form in any direction. Ultimately what causes stiffening, entrapping a nerve, restricting movement, less elasticity, poor circulation, flexibility and leaves the tendon more chance to further injury.
Your doctor will prescribe a series of conservative treatment protocols for you to follow. In most cases, a conservative treatment protocol will be enough to heal the injury, though in cases such as significant tearing or a fully ruptured tendon, you will most probably require surgery. It is generally understood by doctors and surgeons, that surgery will introduce more scar tissue into the any already damaged tissue. This added scar tissue will be problematic, requiring more PT and conservative treatment options post-surgery. If not dealt with properly, your Achilles tendon injury could end up in worse condition than before the surgery! This is why surgery is only performed as a last resort.
Some conservative treatment methods recommended include:
Read more about conservative treatment options for achilles tendonitis by clicking here.
A bursa is a sac of synovial fluid, rich in protein and collagen, that lies between a tendon and a bone to help the tendon glide smoothly over the bone. There are 2 bursae that surround the Achilles tendon to protect it from friction. The retrocalcaneal bursa lies between the tendon and the back, or posterior surface, of the heel bone (calcaneus). This is a "true" bursa that is present from birth. It acts as a cushion between these two structures to protect the tendon from friction against the heel bone.
The larger subcutaneous calcaneal bursa lies overtop of the tendon at the lower part of the heel where the tendon joins to the heel bone. This bursa develops as you age, an "adventitious" bursa, to protect the tendon from friction at the back of the heel.
Bursitis occurs when a bursa is irritated from frequent pressure and it becomes inflamed. When one or both of these bursa become inflamed it is generally referred to as Achilles bursitis because of the bursa's proximity to the Achilles tendon. In some cases, an inflamed bursa can become infected with bacteria (referred to as septic bursitis) and it is necessary to see a doctor to get rid of the infection.
Due to the proximity to the area on the Achilles tendon, Achilles bursitis is often mistaken for tendinitis. Achilles bursitis is a common overuse injury in runners, ice skaters and other athletes.
When you suffer from Achilles bursitis it will be most noticeable when you begin an activity after rest:
Relieving the symptoms of bursitis initially focuses on taking the pressure off the bursa. This can be done with proper cushioning, inserts, or footwear but may require surgery if it is a bone formation problem (i.e. Haglund's Deformity). If your bursitis is caused by an infection (septic bursitis), the doctor will probably drain the bursa sac with a needle and perscribe antibiotics to treat the infection.
For non-infectious bursitis, the preliminary treatment starts with conservative treatment options. Such options typically include cold compression and Circulation Boost. Surgery to remove the inflamed bursa is normally not required for bursitis, however if you fail to see improvement with the conservative treatments, your physician may recommend surgery to remove the bursa completely. Although this removes the problem of an inflamed bursa, you are left with less cushioning in your joint which can lead to other conditions such as fraying of the tendons, muscles or ligaments in the treated area. Eventually, fraying can lead to increasing weakness and rupture in severe cases.
Read more about conservative treatment options for achilles bursitis by clicking here.
Referred pain is the strangest issue to get your head around and it is not exactly a common issue, but can manifest itself via an irritation of the spinal nerve between the fifth lumbar and the first sacral vertebrae. In cases such as referred pain, it goes without saying that you should see a physician to get a proper diagnosis as well as proper treatment. In such instance, a proper treatment may include some back treatments, recommendations for change in posture, anti-inflammatory medications and PT.
I want to learn more about Achilles Surgery & Post-Surgery Recovery
I want to learn more about Circulation Boost
I want to learn more about Ice & Heat: Which Is Better For The Achilles?
I want to learn more about Stretching for the Achilles
I want to learn more about Achilles Injury Treatments
During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort at the location of your soft tissue injury until the pain and inflammation settle. Always consult your doctor and/or Physical Therapist before using any of our outstanding products, to make sure they are right for you and your condition.
Please be aware that this information is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider before using any of our outstanding products to make sure they're right for you and your condition or if you have any questions regarding a medical condition. Always see your doctor for a proper diagnosis as there are often many injuries and conditions (some very serious) that could be the cause of your pain.
© 2021 In.Genu Design Group, Inc.